Highlights from the American College of Gastroenterology's 79th Annual Scientific Meeting

The annual meeting of the American College of Gastroenterology was held from Oct. 17 to 22 in Philadelphia and attracted approximately 5,000 participants from around the world, including gastroenterology and digestive specialists and other health care professionals. The conference featured presentations focusing on clinical updates in gastroenterology and hepatology as well as the latest advances in digestive health and gastrointestinal disorders.

In one study, Elizabeth Jensen, M.P.H., Ph.D., of the University of North Carolina School of Medicine in Chapel Hill, and colleagues assessed whether there was evidence of an association between celiac disease and eosinophilic esophagitis among a large patient population (88,517) undergoing both esophageal and duodenal biopsies. The investigators found evidence of a weak association between the two conditions. Specifically, among those with active celiac disease on biopsy, there was an increase in odds of also having active eosinophilic esophagitis.

"Patients with celiac disease may be at increased risk of having concomitant eosinophilic esophagitis. Patients with celiac disease experiencing esophageal symptoms should be closely examined and/or biopsies obtained to assess for eosinophilic esophagitis during an endoscopy," said Jensen. "The results of this study suggest that both esophageal and duodenal biopsies may be necessary when there is clinical suspicion of either eosinophilic esophagitis or celiac disease. These results also suggest that these conditions may share, for some patients, a similar pathogenesis."

Several authors disclosed financial ties to the pharmaceutical, biotechnology, and diagnostic industries

In a large, statewide, population-based study, Jordan Karlitz, M.D., of the Tulane University School of Medicine in New Orleans, and colleagues found that, despite the risks associated with Lynch syndrome, only 23 percent of young (age 50 and under) colorectal cancer patients are undergoing screening for Lynch syndrome with microsatellite instability and/or immunohistochemistry testing. Screening rates appear to be disproportionately low in patients from rural areas and in patients receiving care at public health care facilities.

"Both population-based and local-level interventions will be required in order to increase screening rates and raise awareness of Lynch syndrome so that testing rates can be optimized. Similarly, more detailed studies will be necessary to better understand the low screening rates so that they can be improved upon in the future," Karlitz said.

Sophia Ali Patel, M.D., of Cleveland Clinic Children's, and colleagues evaluated exhaled volatile organic compounds in breath samples of pediatric patients with a diagnosis of irritable bowel syndrome (IBS), and then compared them to breath samples from healthy children. The investigators found that patients with IBS have a unique "breathprint" compared to healthy control children.

"Having an objective biomarker for IBS could change the way this disease is diagnosed and save the patients from many unnecessary tests. Our results indicate that patients with IBS have differences in the volatile organic compounds in their breath compared to healthy controls. Our hope is that, in the future, a simple breath sample could diagnose IBS with good accuracy," said Patel. "At this point, our study is in its very early phases and will require more patients and further analysis. It is currently a pilot study and we hope to expand it in the future with further research."

In a long-term, open-label safety study of over 300 IBS with constipation (IBS-C) patients who completed 18 months of 290-µg linaclotide, William Chey, M.D., of the University of Michigan in Ann Arbor, and colleagues found that linaclotide was generally well tolerated in patients with IBS-C over the course of up to two years. The most common side effect was diarrhea, which was reported by 32 percent of IBS-C patients. The investigators found that diarrhea adverse events were generally mild or moderate in severity, were managed by dose reduction or temporarily withholding doses, and infrequently led to study withdrawal.

"When starting patients with IBS-C on linaclotide, it is important to inform them that diarrhea is the most common side effect, occurring in up to a third of patients. Patients should take their medication 30 to 60 minutes before breakfast to minimize the chance of getting diarrhea," Chey said. "Most of the time, the diarrhea will improve with dose reduction or withholding a dose or two, but occasionally the diarrhea can be severe (approximately 3 percent). If that happens, patients should discontinue the linaclotide and contact their health care provider. It is interesting that patients with diarrhea in our study had very similar levels of satisfaction with the drug compared to patients who did not report diarrhea."

Several authors disclosed financial ties to pharmaceutical companies, including Ironwood Pharmaceuticals and Forest Laboratories, which manufacture linaclotide and funded the study.

Rebecca Rawl, M.D., M.P.H., and Lauren Browne, M.D., from the Carolinas Medical Center in Charlotte, N.C., found that, despite potential health benefits, chia seeds may pose a risk if they are not consumed properly. The seeds should not be eaten in their dry, raw form, the authors cautioned. This is particularly true for people with a history of dysphagia or a constricted esophagus.